Management of Arterial and Venous Injuries in the Dislocated Knee

Abstract

Although uncommonly encountered, knee dislocation is frequently associated with major vascular injury. Serious injuries resulting in ischemia demand prompt recognition and efficient management to prevent devastating long-term sequelae. In this review, we detail mechanisms of knee dislocation and associated popliteal vascular injuries. Diagnostic modalities used to evaluate the extent of vascular injury are individually discussed. Appropriate initial management of vascular injuries is crucial and an algorithm for diagnosis and management will be reviewed. We elaborate on the salient points of vascular reconstruction in the context of the dislocated knee: surgical approach, conduct of the procedure, and adjunctive maneuvers are described.

External fixator for treatment of the sub-acute and chronic multi-ligament-injured knee

“…Despite their relatively low incidence, these injuries have been widely studied because of their high morbidity, the difficulty in returning to the level of activity prior to the injury and the high complication rate, consisting of loss of range of motion, pain and residual instability due to ligament reconstruction failure [11,14,26].…”

Radiologic Review of Knee Dislocation: From Diagnosis to Repair

“…Hard signs of vascular injury include absent or diminished distal pulses, visible or expanding hematoma, palpable thrill or audible bruit, or pulsatile hemorrhage. These clinical findings alone are indicative of a substantial vascular injury and mandate emergent vascular surgery exploration [25].…”

“…Vascular injury represents a potentially limbthreatening complication of traumatic knee dislocation with a broad range of popliteal artery injury rates in multiple series reported in the literature, ranging from as low as 7% to as high as 64% [1, 13,14,25,31,32]. Owing to an intrinsically poor collateral arterial pathway across the popliteal region, delayed recognition of an occlusive injury beyond 8 hours is likely to result in an above-knee amputation [13,25,31,33].…”

“…Owing to an intrinsically poor collateral arterial pathway across the popliteal region, delayed recognition of an occlusive injury beyond 8 hours is likely to result in an above-knee amputation [13,25,31,33]. When the tibiofemoral joint disarticulates, the popliteal artery has limited ability to accommodate the acute increase in distance across the popliteal fossa because it is tethered proximally at the adductor hiatus (Hunter canal) and distally as it passes behind the fibrous arch of the soleus muscle (soleal arcade).…”

“…Vascular injury is also thought to occur from direct trauma to the vessels by adjacent bony structures, particularly in the setting of a posterior dislocation [25]. An arterial injury can range from a transient kink or occlusion to an intimal tear, dissection, acute thrombosis, or complete transection.…”